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KMID : 1038620230410010012
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Radiation Oncology Journal
2023 Volume.41 No. 1 p.12 ~ p.22
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Safety and efficacy of salvage conventional re-irradiation following stereotactic radiosurgery for spine metastases
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Marcus A. Florez
Brian De
Bhavana V. Chapman
Anussara Prayongrat
Jonathan G. Thomas
Ahn Seo-Yeon
Jun Ju-Hee
Debra N. Yeboa
Andrew J. Bishop
Tina Briere
Behrang Amini
Yoo Soo-Ji
Claudio E. Tatsui
Laurence D. Rhines
Amol J. Ghia
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Abstract
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Purpose : There has been limited work assessing the use of re-irradiation (re-RT) for local failure following stereotactic spinal radiosurgery (SSRS). We reviewed our institutional experience of conventionally-fractionated external beam radiation (cEBRT) for salvage therapy following SSRS local failure.
Materials and Methods : We performed a retrospective review of 54 patients that underwent salvage conventional re-RT at previously SSRS-treated sites. Local control following re-RT was defined as the absence of progression at the treated site as determined by magnetic resonance imaging.
Results : Competing risk analysis for local failure was performed using a Fine-Gray model. The median follow-up time was 25 months and median overall survival (OS) was 16 months (95% confidence interval [CI], 10.8?24.9 months) following cEBRT re-RT. Multivariable Cox proportional-hazards analysis revealed Karnofsky performance score prior to re-RT (hazard ratio [HR] = 0.95; 95% CI, 0.93?0.98; p = 0.003) and time to local failure (HR = 0.97; 95% CI, 0.94?1.00; p = 0.04) were associated with longer OS, while male sex (HR = 3.92; 95% CI, 1.64?9.33; p = 0.002) was associated with shorter OS. Local control at 12 months was 81% (95% CI, 69.3?94.0). Competing risk multivariable regression revealed radioresistant tumors (subhazard ratio [subHR] = 0.36; 95% CI, 0.15?0.90; p = 0.028) and epidural disease (subHR = 0.31; 95% CI, 0.12?0.78; p =0.013) were associated with increased risk of local failure. At 12 months, 91% of patients maintained ambulatory function.
Conclusion : Our data suggest that cEBRT following SSRS local failure can be used safely and effectively. Further investigation is needed into optimal patient selection for cEBRT in the retreatment setting.
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KEYWORD
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Radiosurgery, Re-irradiation, Radiotherapy dosage, Local neoplasm recurrence, Neoplasm metastasis
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